1
NUR 256 Concepts of Mental Health Nursing
ACTUAL EXAM QUESTIONS AND ANSWERS
2026/2027 | Exam 3 | 100% Correct GRADED A |
Pass Guaranteed - A+ Graded
MODULE 1: MOOD DISORDERS (Questions 1-15)
Question 1 A 45-year-old female patient is admitted with major depressive disorder. She reports
feeling "empty and hopeless" for the past 3 months, has lost 15 pounds, and has difficulty
sleeping. Which nursing diagnosis has the highest priority for this patient?
A. Imbalanced Nutrition: Less Than Body Requirements
B. Risk for Suicide [CORRECT]
C. Insomnia
D. Hopelessness
Correct Answer: B
Rationale: Risk for Suicide is always the highest priority in a patient with major depressive
disorder, especially with symptoms of hopelessness and significant weight loss (which can
indicate severe depression). While all diagnoses may be appropriate, safety takes precedence
over all other nursing diagnoses according to Maslow's hierarchy and patient safety standards.
Distractor A (nutrition) is important but not life-threatening in the immediate sense. Distractor C
(insomnia) is a symptom that contributes to depression severity but is not the priority. Distractor
D (hopelessness) is a contributing factor to suicide risk but is addressed after ensuring immediate
safety.
Question 2 The nurse is caring for a patient prescribed fluoxetine (Prozac) for major depressive
disorder. Which statement by the patient indicates understanding of the medication teaching?
A. "I should expect to feel better within 2 to 3 days."
B. "I can stop taking this medication once I feel better."
C. "I may experience sexual side effects, and I should report these to my provider."
,2
[CORRECT]
D. "I should take this medication with grapefruit juice to increase absorption."
Correct Answer: C
Rationale: SSRIs like fluoxetine commonly cause sexual dysfunction (decreased libido,
anorgasmia, erectile dysfunction) in 30-50% of patients. Patients should be informed and
encouraged to report these effects as alternative medications (bupropion, mirtazapine) or
strategies may be available. Distractor A is incorrect – SSRIs take 2-6 weeks for therapeutic
effect, not days. Distractor B is incorrect – abrupt discontinuation can cause discontinuation
syndrome (withdrawal) and relapse; SSRIs must be tapered. Distractor D is incorrect – grapefruit
juice inhibits CYP3A4 metabolism and can increase levels of some medications, but this is not
recommended for patient self-administration.
Question 3 A patient with bipolar I disorder is prescribed lithium carbonate 300 mg three times
daily. Which laboratory value requires immediate notification of the healthcare provider?
A. Lithium level 0.8 mEq/L
B. Lithium level 1.2 mEq/L
C. Lithium level 2.0 mEq/L [CORRECT]
D. Sodium level 142 mEq/L
Correct Answer: C
Rationale: The therapeutic range for lithium is 0.6-1.2 mEq/L for maintenance, up to 1.5 mEq/L
for acute mania. Levels above 2.0 mEq/L indicate severe toxicity requiring immediate
intervention (IV fluids, possible dialysis). Symptoms include severe tremor, ataxia, confusion,
seizures, and renal failure. Distractor A (0.8) is therapeutic. Distractor B (1.2) is at the high end
of therapeutic but acceptable. Distractor D (142 sodium) is normal; however, lithium toxicity risk
increases with hyponatremia (low sodium), not normal sodium.
Question 4 A nursing student asks about the difference between bipolar I and bipolar II
disorders. Which explanation by the nurse educator is most accurate?
A. "Bipolar I has milder manic episodes than bipolar II."
B. "Bipolar II requires hospitalization during depressive episodes."
C. "Bipolar I includes at least one manic episode, while bipolar II has hypomanic and major
depressive episodes." [CORRECT]
D. "Bipolar II includes psychotic features, but bipolar I does not."
Correct Answer: C
,3
Rationale: According to DSM-5-TR criteria, bipolar I disorder requires at least one lifetime
manic episode (may or may not have depressive episodes). Bipolar II requires at least one
hypomanic episode and at least one major depressive episode, with no lifetime manic episodes.
Distractor A is reversed – bipolar I has more severe mania. Distractor B is incorrect –
hospitalization is not diagnostic criteria. Distractor D is incorrect – psychotic features can occur
in both disorders during severe episodes.
Question 5 A patient with seasonal affective disorder (SAD) asks the nurse about light therapy.
Which instruction is most appropriate?
A. "Use the light box for 30 minutes before bedtime to help you sleep."
B. "Sit about 12 inches from a 10,000 lux light box for 30 minutes each morning." [CORRECT]
C. "Stare directly into the light box to get the full benefit."
D. "Use the light box only on cloudy days when you feel depressed."
Correct Answer: B
Rationale: Light therapy for SAD typically involves 10,000 lux for 30 minutes in the early
morning (to reset circadian rhythms). The patient should sit at the recommended distance
(usually 12-24 inches) with eyes open but not staring directly at the light. Distractor A is
incorrect – evening light can worsen insomnia. Distractor C is dangerous and can cause eye
damage. Distractor D is incorrect – light therapy should be used daily during the season, not just
when symptomatic.
Question 6 A patient taking phenelzine (Nardil), an MAOI, asks about dietary restrictions.
Which food item can the patient safely consume?
A. Aged cheddar cheese
B. Red wine
C. Fresh mozzarella cheese [CORRECT]
D. Smoked salmon
Correct Answer: C
Rationale: MAOIs require dietary restrictions to prevent hypertensive crisis from tyramine
accumulation. Fresh cheeses (mozzarella, ricotta, cream cheese, cottage cheese) are safe. Aged
cheeses (A), alcohol (B), and aged/smoked/pickled foods (D) are high in tyramine and
contraindicated. Patients must avoid all aged cheeses, cured meats, fermented foods, and alcohol.
, 4
Question 7 A patient with postpartum depression tells the nurse, "I'm a terrible mother. My baby
would be better off without me." What is the nurse's priority response?
A. "Many new mothers feel this way. It will pass with time."
B. "Tell me more about these thoughts. Are you thinking of hurting yourself or your baby?"
[CORRECT]
C. "Your baby needs you. You should focus on the positive aspects of motherhood."
D. "Have you considered joining a new mothers' support group?"
Correct Answer: B
Rationale: This statement suggests possible suicidal ideation and/or infanticidal thoughts, which
are medical emergencies in postpartum depression. The nurse must directly assess suicide and
homicide risk using non-judgmental, specific questioning. Distractor A minimizes the severity
and is nontherapeutic. Distractor C dismisses the patient's feelings. Distractor D is appropriate
for mild postpartum adjustment but not when safety is concerned.
Question 8 A patient with major depressive disorder has been taking sertraline for 3 weeks
without improvement. The nurse should anticipate which next step?
A. Discontinue sertraline immediately due to treatment failure
B. Increase the dose or wait 1-3 more weeks for therapeutic effect [CORRECT]
C. Add a mood stabilizer like lithium
D. Switch to electroconvulsive therapy
Correct Answer: B
Rationale: Antidepressants typically require 4-6 weeks for full therapeutic effect. At 3 weeks, it
is premature to conclude treatment failure. The provider may increase the dose or continue
monitoring. Distractor A is incorrect – abrupt discontinuation is not indicated. Distractor C is not
first-line for unipolar depression without bipolar features. Distractor D is reserved for treatment-
resistant depression after multiple medication trials.
Question 9 Which patient should the nurse see FIRST?
A. A patient with depression who refuses to attend group therapy
B. A patient with bipolar disorder who is pacing and speaking rapidly
C. A patient with depression who is found with a hidden rope and suicide note [CORRECT]
D. A patient with dysthymia who requests a different roommate
Correct Answer: C
NUR 256 Concepts of Mental Health Nursing
ACTUAL EXAM QUESTIONS AND ANSWERS
2026/2027 | Exam 3 | 100% Correct GRADED A |
Pass Guaranteed - A+ Graded
MODULE 1: MOOD DISORDERS (Questions 1-15)
Question 1 A 45-year-old female patient is admitted with major depressive disorder. She reports
feeling "empty and hopeless" for the past 3 months, has lost 15 pounds, and has difficulty
sleeping. Which nursing diagnosis has the highest priority for this patient?
A. Imbalanced Nutrition: Less Than Body Requirements
B. Risk for Suicide [CORRECT]
C. Insomnia
D. Hopelessness
Correct Answer: B
Rationale: Risk for Suicide is always the highest priority in a patient with major depressive
disorder, especially with symptoms of hopelessness and significant weight loss (which can
indicate severe depression). While all diagnoses may be appropriate, safety takes precedence
over all other nursing diagnoses according to Maslow's hierarchy and patient safety standards.
Distractor A (nutrition) is important but not life-threatening in the immediate sense. Distractor C
(insomnia) is a symptom that contributes to depression severity but is not the priority. Distractor
D (hopelessness) is a contributing factor to suicide risk but is addressed after ensuring immediate
safety.
Question 2 The nurse is caring for a patient prescribed fluoxetine (Prozac) for major depressive
disorder. Which statement by the patient indicates understanding of the medication teaching?
A. "I should expect to feel better within 2 to 3 days."
B. "I can stop taking this medication once I feel better."
C. "I may experience sexual side effects, and I should report these to my provider."
,2
[CORRECT]
D. "I should take this medication with grapefruit juice to increase absorption."
Correct Answer: C
Rationale: SSRIs like fluoxetine commonly cause sexual dysfunction (decreased libido,
anorgasmia, erectile dysfunction) in 30-50% of patients. Patients should be informed and
encouraged to report these effects as alternative medications (bupropion, mirtazapine) or
strategies may be available. Distractor A is incorrect – SSRIs take 2-6 weeks for therapeutic
effect, not days. Distractor B is incorrect – abrupt discontinuation can cause discontinuation
syndrome (withdrawal) and relapse; SSRIs must be tapered. Distractor D is incorrect – grapefruit
juice inhibits CYP3A4 metabolism and can increase levels of some medications, but this is not
recommended for patient self-administration.
Question 3 A patient with bipolar I disorder is prescribed lithium carbonate 300 mg three times
daily. Which laboratory value requires immediate notification of the healthcare provider?
A. Lithium level 0.8 mEq/L
B. Lithium level 1.2 mEq/L
C. Lithium level 2.0 mEq/L [CORRECT]
D. Sodium level 142 mEq/L
Correct Answer: C
Rationale: The therapeutic range for lithium is 0.6-1.2 mEq/L for maintenance, up to 1.5 mEq/L
for acute mania. Levels above 2.0 mEq/L indicate severe toxicity requiring immediate
intervention (IV fluids, possible dialysis). Symptoms include severe tremor, ataxia, confusion,
seizures, and renal failure. Distractor A (0.8) is therapeutic. Distractor B (1.2) is at the high end
of therapeutic but acceptable. Distractor D (142 sodium) is normal; however, lithium toxicity risk
increases with hyponatremia (low sodium), not normal sodium.
Question 4 A nursing student asks about the difference between bipolar I and bipolar II
disorders. Which explanation by the nurse educator is most accurate?
A. "Bipolar I has milder manic episodes than bipolar II."
B. "Bipolar II requires hospitalization during depressive episodes."
C. "Bipolar I includes at least one manic episode, while bipolar II has hypomanic and major
depressive episodes." [CORRECT]
D. "Bipolar II includes psychotic features, but bipolar I does not."
Correct Answer: C
,3
Rationale: According to DSM-5-TR criteria, bipolar I disorder requires at least one lifetime
manic episode (may or may not have depressive episodes). Bipolar II requires at least one
hypomanic episode and at least one major depressive episode, with no lifetime manic episodes.
Distractor A is reversed – bipolar I has more severe mania. Distractor B is incorrect –
hospitalization is not diagnostic criteria. Distractor D is incorrect – psychotic features can occur
in both disorders during severe episodes.
Question 5 A patient with seasonal affective disorder (SAD) asks the nurse about light therapy.
Which instruction is most appropriate?
A. "Use the light box for 30 minutes before bedtime to help you sleep."
B. "Sit about 12 inches from a 10,000 lux light box for 30 minutes each morning." [CORRECT]
C. "Stare directly into the light box to get the full benefit."
D. "Use the light box only on cloudy days when you feel depressed."
Correct Answer: B
Rationale: Light therapy for SAD typically involves 10,000 lux for 30 minutes in the early
morning (to reset circadian rhythms). The patient should sit at the recommended distance
(usually 12-24 inches) with eyes open but not staring directly at the light. Distractor A is
incorrect – evening light can worsen insomnia. Distractor C is dangerous and can cause eye
damage. Distractor D is incorrect – light therapy should be used daily during the season, not just
when symptomatic.
Question 6 A patient taking phenelzine (Nardil), an MAOI, asks about dietary restrictions.
Which food item can the patient safely consume?
A. Aged cheddar cheese
B. Red wine
C. Fresh mozzarella cheese [CORRECT]
D. Smoked salmon
Correct Answer: C
Rationale: MAOIs require dietary restrictions to prevent hypertensive crisis from tyramine
accumulation. Fresh cheeses (mozzarella, ricotta, cream cheese, cottage cheese) are safe. Aged
cheeses (A), alcohol (B), and aged/smoked/pickled foods (D) are high in tyramine and
contraindicated. Patients must avoid all aged cheeses, cured meats, fermented foods, and alcohol.
, 4
Question 7 A patient with postpartum depression tells the nurse, "I'm a terrible mother. My baby
would be better off without me." What is the nurse's priority response?
A. "Many new mothers feel this way. It will pass with time."
B. "Tell me more about these thoughts. Are you thinking of hurting yourself or your baby?"
[CORRECT]
C. "Your baby needs you. You should focus on the positive aspects of motherhood."
D. "Have you considered joining a new mothers' support group?"
Correct Answer: B
Rationale: This statement suggests possible suicidal ideation and/or infanticidal thoughts, which
are medical emergencies in postpartum depression. The nurse must directly assess suicide and
homicide risk using non-judgmental, specific questioning. Distractor A minimizes the severity
and is nontherapeutic. Distractor C dismisses the patient's feelings. Distractor D is appropriate
for mild postpartum adjustment but not when safety is concerned.
Question 8 A patient with major depressive disorder has been taking sertraline for 3 weeks
without improvement. The nurse should anticipate which next step?
A. Discontinue sertraline immediately due to treatment failure
B. Increase the dose or wait 1-3 more weeks for therapeutic effect [CORRECT]
C. Add a mood stabilizer like lithium
D. Switch to electroconvulsive therapy
Correct Answer: B
Rationale: Antidepressants typically require 4-6 weeks for full therapeutic effect. At 3 weeks, it
is premature to conclude treatment failure. The provider may increase the dose or continue
monitoring. Distractor A is incorrect – abrupt discontinuation is not indicated. Distractor C is not
first-line for unipolar depression without bipolar features. Distractor D is reserved for treatment-
resistant depression after multiple medication trials.
Question 9 Which patient should the nurse see FIRST?
A. A patient with depression who refuses to attend group therapy
B. A patient with bipolar disorder who is pacing and speaking rapidly
C. A patient with depression who is found with a hidden rope and suicide note [CORRECT]
D. A patient with dysthymia who requests a different roommate
Correct Answer: C
